Up & Running

Physioplus is up & running in our effort to present you with topical information, solutions and promotions. This edition will focus on overuse injuries of the lower limb - relevant now during winter sports and with marathon season coming up.

In this edition:

  • Achilles tendonopathy - incidence and presentation
  • Biomechanics & Education - the link to effective treatment
  • Custom Orthotics - a good deal on a great product
  • Get Active Again - the benefits of exercise rehabilitation
  • FIFA World Cup Comp - email to enter and wear the socceroos  shirt
  • Presentation - Tendonitis, Tapas and a Taste of good wine - Physioplus and our neighbours at the Wine Bar in Ballina on Thursday August 5th

Achilles Tendinopathy

Achilles tendonopathy, is a relatively common condition (11% of all running injuries) characterized by tissue damage and pain in the Achilles region. It is a degenerative, not an inflammatory condition. Excessive, repetitive overload of the tendon is regarded as the main pathological stimulus that leads to tendinopathy. Damage to the tendon can occur even if it is stressed within its physiological limits when the frequent cumulative microtrauma applied do not leave enough time to repair.

Signs and Symptoms
Patients with this condition typically experience pain in the region of the heel and back of the ankle which differ depending on the severity of the condition.

  • Stage 1. No pain during exercise. Discomfort initially in the morning, then fine for the remained of the day.
  • Stage 2. Pain during exercise or running, but performance is not affected. Discomfort initially in the morning, then fine for the remained of the day.
  • Stage 3. Pain during exercise or running that is detrimental to performance. Discomfort initially in the morning, but may continue for some time and reappear at other points during the day.
  • Stage 4. Hurts too much to exercise or run. Pain and stiffness worse in the morning but may continue for most of the day.

A more specific measure (VISA-A Questionnaire) is a reliable and valid tool to determine the severity of Achilles Tendinopathy using a 100 point scale.  The earlier treatment commences, the more easily and quickly recovery will occur. If not addressed, it is more likely to progress to stage 4, which increases the chance of complete rupture of the Achilles tendon - requiring surgery and prolonged rehab!

What can patients do now?
Rest from aggravating activity. Wear shoes with a heel lift to reduce tension on the tendon. Ice for 15 minutes 3 x daily. Commence gently calf stretches. Consult a Physiotherapist.

What will a Physiotherapist do?
Physiotherapy is supported by the latest research:

  • Most patients with AT experience a reduction in pain after only 4 weeks of differentiated non-surgical treatment consisting of Physiotherapy or semi-rigid orthotics.(Mayer, Hirchmuller, Muller et al, 2007)
  • Alfredson's eccentric exercises in combination with biomechanical assessment, massage and electrotherapy (over 6-12 weeks) will resolve AT in the majority of cases. (Alfredson and Cook, 2007).
  • Eccentric strengthening exercises, Physiotherapy modalities, insertion of heel lift (to unload the tendon), gastrocs/soleus complex stretches are all helpful for treating people with AT. (Simpson & Howard, 2009) There is growing evidence to suggest that eccentric exercises performed with ‘moderate' but not ‘disabling' levels of pain, have greater improvements in pain and function than those avoiding pain. The program may take 6-12 weeks.
  • Deep frictional massage - may activate mesenchymal stem cells to stimulate a healing response - has been successful in Achilles tendinopathy (Testa V, Ruggiu M, Capasso G. 1996)

Biomechanics & Education - the link to long term relief

Our physiotherapists will consider the FITT principal to control forces on a damaged tendon during rehab and return to function.

F = Frequency - is there enough rest between sessions to allow recovery from microtruama

I = Intensity - advice on increasing speed, terrain, resistence without increasing symptoms

T = Time - accommodating increased load

T = Technique - advice of footwear, flexibility, biomechanics and orthotics

Custom Orthotics - a good deal on a great product

We use Gaitscan technology and our clinical experience to decide if you will benefit from custom orthotics. The Orthotic Group (TOG) is a world leader in custom orthotics www.theorthoticgroup.com. Our orthotics are low profile, comfortable and flexible. At $390 per pair they represent great value. Until October we are offering a second pair of orthotics for an additional $60. Have a pair for work as well as running, golf or football - TOG offers specialised orthotics to suit your activity. Email us at physioplus@bigpond.com to request a fact sheet on orthotics

Get active again!

The Active Again program is an exercise rehabilitation service offered in our Lismore and Ballina gyms as a progression of treatment following injury or surgery, or for the preparation for return to sport of injured athletes and weekend warriors.

The service is offered by experienced exercise physiologist Tim Boyd who has a special interest in the rehabilitation of musculoskeletal pain and injury.

Active Again participants receive individual instruction and supervision of an exercise rehabilitation and conditioning program which may offer benefits such as:

  • Progressive restoration of functional and sports specific capabilities
  • Improved posture to aid muscle and joint function
  • Improved running and throwing bio-mechanics
  • Improved joint stabilisation
  • Improved muscle strength and endurance
  • Sport and injury specific warm-up strategies

Tim is an accredited exercise physiologist and member of Exercise and Sports Science Australia, which enables Active Again participants to access Private Health Insurance rebates.

To learn more go to the Active Again page on our website

FIFA World Cup Competition

Here is your chance to wear the winning team's shirt. Email us at physioplus@bigpond.com and the first xx to apply will be allocated a team in the final round. We will let you know who to cheer for, and will check in on what size for the winners shirt.

Presentation - Tendonitis, Tapas and a Taste of Good Wine

Join us on Thursday July xxx at from 5.30 pm for an informal presentation on lower limb overuse injuries. We will demonstrate clinical tests and explain the rationale for physiotherapy treatment of achilles tendonitis, severs traction apophysitis and tibialis posterior tendonitis. Enjoy tapas and a taste of good wine from our neighbours at The Wine Bar - Riverside Apartments - Fawcett Street Ballina 5.30 til 7.30 pm. Please RSVP by email to physioplus@bigpond.com

If you would like more information on the services we offer go to www.physioplus.info

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